Are Cervical Checks During Labour Necessary?

As a doula and birth educator, I’m often asked: are cervical checks during labour necessary?

A cervical check is when your doctor or midwife measures cervix dilation.

Care providers use this measurement to determine how you’re progressing during labour.

Many women, however, find cervical checks very uncomfortable or even painful.

Are Cervical Checks During Labour Necessary?

In hindsight, they might wonder whether cervical checks during labour were really necessary. Or whether they can just say no to cervical checks next time they are pregnant.

What Do Cervical Checks Tell Us?

Cervical or vaginal exams are the most widely accepted way for care providers to decide how labour is progressing. But are cervical checks during labour necessary?

A cervical examination provides information about:

Dilation or widening of the cervix

Effacement or thinning of the cervix

Position of the cervix (whether it’s facing back or forward)

How the baby is lying

Position of baby in pelvis (high or descended)

How the baby’s head is presenting on the cervix

When you go into hospital, your care provider will offer to do a cervical check. This is to help confirm that you are in active or established labour.

Generally, in women who are in active labour, the cervix has thinned and is around 3-5 centimetres dilated.

If you go into hospital too early, there’s a chance you will sent back home. If you stay, this can lead to interventions.

Care providers use the information from cervical checks to decide whether labour is progressing.

What Are The Problems With Cervical Checks?

#1: Lack Of Evidence To Support The Use Of Cervical Checks

Cervical examinations during labour are routine in many hospitals. We could assume there’s evidence-based research to show this procedure reduces poor outcomes for both mothers and babies.

In fact, according to this Cochrane review, there’s no convincing evidence to show routine cervical exams during labour are of benefit.

The reviewers looked for research and found two studies, both from the 1990s, and done in high income countries. The studies were small and the quality was unclear.

The authors noted their surprise in discovering cervical checks were so widely used without good evidence of their effectiveness.

#2: Cervical Checks Aren’t The Only Way To Decide If Labour Is Active

If you’re birthing at a hospital, you’re expected to have a cervical check when you arrive. This is done to make sure you’re actually in labour.

Most hospitals have a policy that says labour is regarded as active at 4cms dilation.

However, a cervical check isn’t the only way to tell you’re in labour. Women in early labour tend to move and talk through their contractions.

When they stop to concentrate or focus during contractions, this is a good indication that active labour is established.

#3: Cervical Checks Can’t Predict The Future

There’s a huge temptation for women to want to know how dilated they are – especially if they’ve had hours or even days of early labour.

They might be tired, or worried about how much longer labour will last. Or whether they need pain relief.

If they hear they are ‘only’ so many centimetres dilation, their resolve and confidence can melt away.

As a result, the stress they feel about not having progressed ‘enough’ brings oxytocin and endorphin production down. The knock-on effects are the slowing down, or even stalling of contractions, and more pain.

Remember, cervical checks can provide information about how dilated your cervix is at the moment the check is done.

It cannot predict how long labour will last, or when you will give birth.

#7: Cervical Checks Can Confirm Full Dilation

Cervical checks are often done during transition or when you start pushing. This is to see if the cervix is fully dilated.

In an undisturbed labour, the labouring woman will gradually feel more ‘pushy’ with each long, strong contraction.

She’ll make deep throaty sounds during contractions. She is likely to ‘wake up’ as adrenaline prepares her for the hard work of pushing.

If she’s not stressed or afraid, she will go with each sensation and let her body do the work. She might feel the urge to bear down with the contractions. Her body might even push the baby out with the fetal ejection reflex.

However, there’s a concern a woman will push against her cervix before it is fully dilated; this can cause swelling or even tearing.

This is unlikely to happen unless:

She is lying on her back

She is strapped to the bed because of fetal monitoring

Stress is affecting the progression of labour.

Are Cervical Checks During Labour Necessary?

Cervical checks are procedures that have no evidence to support or reject their use.

They don’t improve outcomes for mothers or babies.

In spite of that, many care providers believe cervical checks during labour are necessary.

And if a woman needs interventions for medical reasons, a cervical check can help her make informed choices about her care.

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Sam McCulloch Dip CBEdCONTRIBUTOR

Sam McCulloch enjoyed talking so much about birth she decided to become a birth educator and doula, supporting parents in making informed choices about their birth experience. In her spare time she writes novels. She is mother to three beautiful little humans.

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